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7043591 FSBGD MCQ Study Questions 2001

7043591 FSBGD MCQ Study Questions 2001



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FSBGD WRITTEN BOARD QUESTION STUDY GUIDE 2000 1. According to the July 1997American Heart Association recommendations, which of the following requireantibiotic prophylaxis for invasive dental treatment? 1. 2. 3. 4. 5. Organic heartmurmur with regurgitation Cardiac pacemakers Isolated secundum atrial septaldefect Previous history of endocarditis Most artificial joint patients a. b. c. d.e. 1,4 2,5 1,3,4 1,4,5 1,3,4,5Endocarditis prophylaxis is not recommended for: (1) isolated secundum atrialseptal defect; (2) surgical repair of atrial septal defect; ventricular septaldefect, or patent ductus arteriosus (without residua beyond 6 months); (3)previous coronary artery bypass graft surgery; (4) mitral valve prolapse withoutvalvar regurgitation; (5) physiologic, functional, or innocent heart murmurs; (6)previous Kawasaki disease without valvar dysfunction; (7) previous rheumatic feverwithout valvar dysfunction; and (8) cardiac pacemakers (intravascular andepicardial) and implanted defibrillators. JADA, Vol, 128, August 1997. pp 1142-1151. An expert panel of dentists, orthopaedic surgeons, and infectious diseasespecialists, performed a thorough review of all available data to determine theneed for antibiotic prophylaxis to prevent hamatogenous prosthetic jointinfections in dental patients who have undergone total joint arthroplasties. Theresult is a report adopted by both organizations as an advisory statement.Conclusion: Antibiotic prophylaxis is not indicated for dental patients with pins,plates and screws, nor is it routinely indicated for most dental patients withtotal joint replacements. Patients at potential increased risk of hematogenoustotal joint infection include: Immunocompromsied / immunosuppressed patients suchas (a) patients with disease-, drug-, or radiation-induced immunosuppression; (b)patients with inflammatory arthropathies such as rheumatoid arthritis and systemiclupus erythematosus. Other patients at increased risk include (a) type Idiabetics; (b) patients with previous prosthetic joint infections; (c)malnourished patients; and (d) hemophilic patients. JADA, Vol. 128, July 1997. pp1004-1008. The correct answer is: A. 1,42. Which of the following groups of drugs has the greatest potential for diverseside effects when they are being administered to a patient undergoing localanesthesia with a vasoconstrictor? a. b. c. d. e. Anticoagulants tranquilizersmono-amine oxidase inhibitors barbiturates analgesicsAlthough the potential for interactions involving local anesthetics is great,clinical manifestations appear infrequently and only when very large doses areused or when unusual patient factors are present. Much more likely to occur areinteractions between various drugs and the vasoconstrictors employed during
local anesthesia. Despite statements to the contrary, local anesthetics containingepinephrine may be used without special reservation in patients taking monoamineoxidase inhibitors..Of the vasoconstrictors currently added to local anestheticsolutions, phenylephrine is contraindicated with concomitant MAO therapy.Vasoconstrictor- added to slow the absorption of the local anesthetic. Thisresults in (a) increased depth and duration of anesthesia, (b) reduced toxicity ofthe local anesthesia, and (c) improved hemostasis at local site. Epinephrine, inconcentrations of 4 to 20 ug/ml (1:250,000 to 1:50,000) is the most frequentlyemployed agent, but levonordefrin, norepinephrine, and phenylephrine are alsoused. Pharmacology and therapeutics for dentistry, Neidle, Kroegerand Yagiela1980, pp 263-283. The following paper discusses vasoconstrictors and druginteraction. The author rates each drug interaction from 1-(major problemestablished )to 5-(minor or unlikely). The following all have ratings of 1.Tricyclic Antidepressants – May modify cardiovascular response tovasoconstrictors. B-Adrenergic Antagonists – May cause bradycardia leading tocardiac arrest. General Anesthetics – Enhances the dysrhythmogenic potential ofadrenergic drugs. Cocaine – Prevents active re-uptake of norepinephrine thereforepotentiates the effect of adrenergic vasoconstrictors. Yagiela HA Adverse druginteractions in dental practices: interactions associated with vasoconstrictors(Part V). JADA, 130:701-709, 1999. Considering all of the potential adversereactions of epinephrine use, it is essential that the clinician make every effortto minimize epinephrine administration, obtain an adequate medical history, andminimize stress. The maximum recommended dose of epinephrine for a healthy adultis 0.2 milligrams, while for the patient with cardiovascular disease, it is 0.04milligrams. In cases where the use of a vasoconstrictor is absolutelycontraindicated (hyperthyroidism and pheochromocytoma), and agent such as 3%mepivacaine without a vasoconstrictor should be used. Oral Med Handout –Assessment of Adverse Reactions to Local Anesthetics The correct answer is C. 3. Apatient presents with fractures of the maxillae, orbits and ethmoid bones. Thismidface trauma can be classified as: a. b. c. d. e. Pyramidal fracture Horizontalfracture Leforte 1 Leforte 2 Leforte 3The LeFort I fracture frequently results from the application of horizontal forceto the maxilla, which separates the maxilla from the pterygoid plates and nasaland zygomatic structures. This type of trauma may separate the maxilla in onepiece from other structures, split the palate, or fragment the maxilla. Forcesthat are applied in a more superior direction frequently result in LeFort IIfractures, which is the separation of the maxilla and the attached nasal complexfrom the orbital and zygomatic structure. A LeFort III fracture results whenhorizontal forces are applied at a level superior enough to separate the naso-orbital ethmoid complex, the zygomas, and the maxilla from the cranial base, whichresults in a socalled craniofacial separation. Peterson, L.J., et al, ContemporaryOral and Maxillofacial Surgery, 1998, Mosby
A horizontal fracture (LeFort I) is one in which the body of the maxilla isseparated from the base of the skull above the level of the palate and below theattachment of the zygomatic process. It results in a freely movable upper jaw. Thepyramidal fracture (LeFort II) is one that has vertical fractures through thefacial aspects of the maxillae and extends upward to the nasal and ethmoid bones.It usually extends through the maxillary antra. One malar bone may be involved.Kruger, G.O., Textbook of Oral and Maxillofacial Surgery, 1984, Mosby The correctanswer is e. Leforte 3. 4. Traumatic tattoos can be minimized or corrected by allof the following except: a. Use of high pressure lavage b. Minimal use of salineirrigation c. Use of a dermabrader d. Use of soap and water and vigorous scrubbinge. Removal of oily substances by acetone Abrasions are often produced by traumathat allows dirt, cinders, or other debris to be ground into the tissue. Ifallowed to remain in the wound, a traumatic tattoo will result. These particlesshould be removed by mechanical cleansing. They should be cleansed with one of thedetergent soaps and then isolated with sterile towels. A local anesthetic is theninjected and the involved area is meticuloulsy scrubbed with a detergent soap onsterile gauze. Frequent irrigation of the field with sterile saline solution aidsin washing the particles form the wound. The use of an electric dermabrader forthe removal of large areas of imbedded particles has been recommended. Theprocedure is tedious and time consuming, but removal of these particles isextremely important. The correct answer is E. Kruger, G.O., Textbook of Oral andMaxillofacial Surgery, 1984, Mosby 5. A shift to the left in the patient’s WBCmeans a _____ in the number of ________. a. b. c. d. e. decrease; neutrophilsincrease; immature neutrophils decrease; immature leucocytes increase; matureleucocytes increase; eosinophilsAnswer: b. increase in number of immature neutrophils Normal Findings Total WBCs:Adult/child>2 years: 5000-10,000/mm 3 or 5-10.0 x 109 /L (SI units) Differentialcount Neutrophils: 55% to 70% Lymphocytes: 20% to 40% Monocytes: 2% to 8%Eosinophils: 1% to 4% Basophils: 0.5% to 1.0% The WBC count has two components.One is a count of the total number of WBCs (leukocytes) in 1 mm 3 of peripheralvenous blood. The other component, the differential count, measures the percentageof each type of leukocyte present in the same specimen. An increase in thepercentage of one type of

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